Advantages
• PCA shortens the interval from the time of patient-defined need to the time of actual analgesic administration- more immediate relief of incident (breakthrough) pain
• Same degree of analgesia compared to other delivery systems with the less/same total amount of medication.
• Provides patients with a greater sense of personal control over their pain

PCA devices.
Most devices have a drug reservoir and infusion system whereby PCA administration can occur with or without a background continuous infusion. Thus, PCA devices need the following orders;
1. PCA dose in mg or mcg (‘patient initiated dose,’ ‘patient demand dose,’ or ‘bolus dose’),
2. Delay interval (’lockout’) – in minutes (period during which the patient cannot obtain additional demand medication),
3. Continuous infusion (CI) Rate in mg/hr or mcg/hr (if CI is used), and
4. Hour limit – maximum amount of drug to be dispensed in a defined period of time. Often the one hour limit is set to deliver 3-5 times the estimated required hourly dose. (Note: due to the need for frequent dose adjustments, the hour limit is often omitted in palliative care)

Indications
• The primary indication for PCA is the patient who requires parenteral analgesia (e.g. severe pain and/or oral/transdermal/rectal route not useable) and has incident pain or other pain patterns that are not predictable.
• PCA is also indicated for use in acute, severe pain as a method of rapid dose titration and dose finding.

Relative contraindications include patients who
• Do not have the cognitive ability to understand how to use a PCA device, or
• The anticipated need for parenteral opioids is less than 24 hours.

Opioids used in PCA devices include morphine, hydromorphone, fentanyl, and methadone.

Routes of administration: IV or SQ are the most common routes of administration; also be used with epidural or intrathecal opioid administration.

Risk of overdose: the patient who is pushing his or her own PCA button will fall asleep before serious signs of overdose occur as long as only the patient pushes the button

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